The Effectiveness of Psychologically Informed Environments in Homelessness Services: A Systematic Review

Abstract

Objectives: Psychologically informed environments have shown promise in supporting people experiencing homelessness, yet evidence of effectiveness and mechanisms is lacking. This systematic review evaluated current evidence on their effectiveness in homelessness settings. Methods: A mixed-method approach combined quantitative evaluation studies with qualitative studies exploring mechanisms for change. Searches were conducted in MEDLINE, PsycINFO and CINAHL Plus, the Centre for Homelessness Impact Databases and Google, to identify published and grey literature using terms associated with psychologically informed environments, homelessness and impact (final search: 7 February 2024). Studies reporting psychologically informed environments involving people experiencing homelessness across all designs, dates and global locations were included. Studies without homelessness outcomes were excluded. Risk of bias was undertaken using the Centre for Homelessness Impact Tool. The quantitative component focused on studies evaluating outcomes concerning changes in behaviour, attitudes and symptoms. The qualitative component provided potential mechanisms for change. Findings were synthesised narratively, grouping findings in four domains: staff attitudes, staff well-being, client behaviour and client well-being. Results: Thirteen studies met inclusion criteria. Staff outcomes showed reduced burnout and improved well-being (3 studies, 521 participants), while client outcomes demonstrated improved mental health and social behaviour (4 studies, 305 participants). Possible mechanisms for change (12 studies, 412 participants) included training, reflective practice and supportive relationships for staff. For clients, person-centred relationships, safe environments and empowerment were cited. Conclusions: Psychologically informed environments show benefits to both staff and clients in homelessness settings, enhancing well-being, engagement and behavioural outcomes. However, the evidence base remains small and inconsistent, and lacking in equity-focused or participatory research. Greater involvement of people with lived experience and use of robust, controlled designs are needed to strengthen future evaluations and clarify how psychologically informed environments achieve their impact.